Castello M A, Schiavetti A, Varrasso G, Clerico A, Cappelli C
Department of Pediatrics, University La Sapienza, Rome, Italy.
Childs Nerv Syst. 1998 Jan-Feb;14(1-2):6-9. doi: 10.1007/s003810050165.
The role of chemotherapy (CHT) in the management of low-grade astrocytoma (LGA) is still unclear. Nineteen children with nonresectable symptomatic LGA were treated with carboplatin (CBDCA) and etoposide (E). There were 15 newly diagnosed cases and 4 were relapses; 6 of the children were under 5 years old. In all children radiological evaluation by CT scan and/or MRI was performed after four courses of CHT. We observed complete response (CR)+ minor response (MR) in 37% of these cases and an improvement in neurological symptoms in 63%. Radiological evaluation performed in 6 patients who received CHT for longer periods (8-12 courses) showed major responses (CR+PR) in 67%. Local radiotherapy (40 Gy) was administered after CHT in 14 cases, but in 3 of these radiotherapy was delayed for 2 years. Five patients did not receive radiotherapy. The overall survival was 58% after an average follow-up of 60 months. All patients with brain stem tumors died of progressive disease even though 3 of these had shown clinical improvement after chemotherapy. In conclusion, in the treatment of nonresectable symptomatic LGA, CHT with CBDCA associated with E can be used to postpone radiotherapy in young children and even to avoid radiotherapy in some cases.
化疗（CHT）在低级别星形细胞瘤（LGA）治疗中的作用仍不明确。19例有症状且无法切除的LGA患儿接受了卡铂（CBDCA）和依托泊苷（E）治疗。其中15例为新诊断病例，4例为复发；6名儿童年龄在5岁以下。所有儿童在接受四个疗程的CHT后均通过CT扫描和/或MRI进行了影像学评估。我们观察到这些病例中有37%达到完全缓解（CR）+轻微缓解（MR），63%的患儿神经症状有所改善。对接受更长疗程（8 - 12个疗程）CHT的6例患者进行的影像学评估显示，67%达到主要缓解（CR + PR）。14例患者在CHT后接受了局部放疗（40 Gy），但其中3例放疗延迟了2年。5例患者未接受放疗。平均随访60个月后总生存率为58%。所有脑干肿瘤患者均死于疾病进展，尽管其中3例在化疗后临床症状有所改善。总之，在有症状且无法切除的LGA治疗中，CBDCA联合E的CHT可用于推迟幼儿放疗，甚至在某些情况下可避免放疗。
